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1.
Sci Rep ; 10(1): 8307, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32433470

RESUMO

Anxiety and depression are commonly found in patients with diabetes, but little is known about how the anxiety and depression symptoms of diabetes patients and the health-related quality of life (HRQoL) over time influence each other. Therefore, we conducted a survey among patients with diabetes (T1) and repeated the survey after 3 months (T2). Linear regression models and cross-lagged structural equation models were used to analyze the associations between anxiety and depression symptoms and HRQoL within and across time intervals. Correcting for baseline index and potential confounders, the HRQoL index at T2 reflected the change in anxiety/depression between T1 and T2 more than anxiety/depression at T1 (P < 0.05). Similarly, anxiety and depression at T2 reflected the change in the EQ-5D index over time more than the index at baseline (P < 0.05). Our longitudinal data fitted well in a cross-lagged model with bi-directional pathways of associations between anxiety and HRQoL, as well as depression and HRQoL, among adult patients with diabetes (x2/df = 1.102, P = 0.256; CFI = 1.000, RMSEA = 0.030). Our findings support early detection of anxiety and depression, as well as comprehensive efforts improving HRQoL for patients with diabetes.

2.
Artigo em Inglês | PAHO-IRIS | ID: phr-52084

RESUMO

[ABSTRACT]. Objective. To identify specific health care areas whose optimization could improve population health in the Dutch Caribbean islands of Aruba and Curaçao. Methods. Comparative observational study using mortality and population data of the Dutch Caribbean islands and the Netherlands. Mortality trends were calculated, then analyzed with Joinpoint software, for the period 1988–2014. Life expectancies were computed using abridged life tables for the most recent available data of all territories (2005–2007). Life expectancy differences between the Dutch Caribbean and the Netherlands were decomposed into cause-specific contributions using Arriaga’s method. Results. During the period 1988–2014, levels of amenable mortality have been consistently higher in Aruba and Curaçao than in the Netherlands. For Aruba, the gap in amenable mortality with the Netherlands did not significantly change during the study period, while it widened for Curaçao. If mortality from amenable causes were reduced to similar levels as in the Netherlands, men and women in Aruba would have added, respectively, 1.19 years and 0.72 years to their life expectancies during the period 2005–2007. In Curaçao, this would be 2.06 years and 2.33 years. The largest cause-specific contributions were found for circulatory diseases, breast cancer, perinatal causes, and nephritis/nephrosis (these last two causes solely in Curaçao). Conclusions. Improvements in health care services related to circulatory diseases, breast cancer, perinatal deaths, and nephritis/nephrosis in the Dutch Caribbean could substantially contribute to reducing the gap in life expectancy with the Netherlands. Based on our study, we recommend more in-depth studies to identify the specific interventions and resources needed to optimize the underlying health care areas.


[RESUMEN]. Objetivo. Determinar las áreas específicas de atención de salud cuya optimización podría mejorar la salud de la población en las islas del Caribe holandés de Aruba y Curaçao. Métodos. Estudio de observación comparativo en el que se utilizaron datos demográficos y de mortalidad de las islas del Caribe holandés y de los Países Bajos. Se calcularon las tendencias de mortalidad y luego se analizaron con programas de computación Jointpoint de regresión lineal segmentada, para el período 1988–2014. La esperanza de vida se calculó utilizando tablas de mortalidad abreviadas con los datos más recientes disponibles de todos los territorios (2005–2007). Las diferencias de esperanza de vida entre el Caribe holandés y los Países Bajos se desglosaron, usando el método de Arriaga, en contribuciones por causas específicas. Resultados. En el período 1988–2014, los niveles de mortalidad por causas evitables mediante la atención de salud han sido sistemáticamente mayores en Aruba y Curaçao que en los Países Bajos. En el caso de Aruba, la brecha en la mortalidad por causas evitables mediante la atención de salud con respecto a los Países Bajos no varió significativamente durante el período de estudio; en el caso de Curaçao, la brecha fue mayor. Si la mortalidad por causas evitables mediante la atención de salud se redujese a un nivel similar al de los Países Bajos, los hombres y las mujeres en Aruba habrían sumado, respectivamente, 1,19 años y 0,72 años a su esperanza de vida en el período 2005–2007. En Curaçao, el aumento hubiese sido de 2,06 años y de 2,33 años. Según el estudio, las causas específicas que más contribuyen a esta diferencia son las enfermedades circulatorias, el cáncer de mama, las complicaciones perinatales, y la nefritis/nefrosis (estas últimas dos causas solamente en Curaçao). Conclusiones. Una mejora en los servicios de salud en relación con las enfermedades circulatorias, el cáncer de mama, las complicaciones perinatales, y la nefritis/nefrosis en el Caribe holandés podría contribuir sustancialmente a la reducción de la brecha en la esperanza de vida con respecto a los Países Bajos. Por tanto, con base en nuestro estudio, recomendamos que se realicen más estudios exhaustivos a fin de determinar las intervenciones específicas y los recursos que se necesitan para optimizar las áreas de atención de salud involucradas.


[RESUMO]. Objetivo. Identificar áreas específicas da atenção à saúde cuja otimização poderia melhorar a saúde da população nas ilhas de Aruba e Curaçao, no Caribe holandês. Métodos. Estudo observacional comparativo baseado em dados de mortalidade e populacionais das ilhas do Caribe holandês e dos Países Baixos. As tendências de mortalidade foram calculadas e então analisadas com o software Joinpoint, no período de 1988 a 2014. As expectativas de vida foram computadas usando tábuas de mortalidade resumidas com os dados disponíveis mais recentes de todos os territórios (2005-2007). As diferenças na expectativa de vida entre o Caribe holandês e os Países Baixos foram desagregadas segundo as contribuições específicas por causa usando o método de Arriaga. Resultados. No período de 1988 a 2014, os níveis de mortalidade evitável foram consistentemente mais elevados em Aruba e Curaçao do que nos Países Baixos. Em Aruba, a diferença na mortalidade evitável em comparação com os Países Baixos não mudou significativamente durante o período do estudo, enquanto que em Curaçao a diferença aumentou. Se a mortalidade por causas evitáveis fosse reduzida a níveis semelhantes aos dos Países Baixos, os homens e mulheres de Aruba teriam aumentos respectivos de 1,19 e 0,72 anos nas suas expectativas de vida durante o período 2005-2007. Em Curaçao, o aumento seria de 2,06 e 2,33 anos. As maiores contribuições de causas específicas foram as de doenças circulatórias, câncer de mama, causas perinatais e nefrite/nefrose (estas duas últimas causas somente em Curaçao). Conclusões. Melhorias nos serviços de saúde relacionados com doenças circulatórias, câncer de mama, mortes perinatais e nefrite/nefrose no Caribe holandês poderiam contribuir substancialmente para reduzir as disparidades na expectativa de vida em comparação com os Países Baixos. Com base neste trabalho, recomendamos estudos mais aprofundados para identificar as intervenções e recursos específicos necessários para otimizar estas áreas da atenção à saúde.


Assuntos
Avaliação em Saúde , Indicadores de Qualidade em Assistência à Saúde , Aruba , Curaçao , Países Baixos , Avaliação em Saúde , Indicadores de Qualidade em Assistência à Saúde , Curaçao , Países Baixos , Avaliação em Saúde , Indicadores de Qualidade em Assistência à Saúde , Curaçao , Países Baixos
3.
Artigo em Inglês | MEDLINE | ID: mdl-32106465

RESUMO

We aimed to gain insight into the barriers and facilitators to fall risk screening of older adults visiting the hospital as experienced by patients and healthcare professionals, and to examine the differences between chronic- and acute-care patients. We invited patients (≥ 70 years) attending the nephrology and emergency department to participate in the screening. Patients and their healthcare professionals were asked to complete a self-administered questionnaire based on the "Barriers and Facilitators Assessment Instrument". Differences in barriers and facilitators between acute- and chronic-care patients were examined with chi-square tests. A total of 216 patients were screened, and 103 completed the questionnaire. They considered many factors as facilitators, and none as barriers. Acute-care patients were more positive than chronic-care patients about healthcare worker characteristics, such as knowledge and skills. After screening, patients were more open to receiving advice regarding fall prevention. The 36 healthcare professionals considered program characteristics to be facilitators and mainly factors regarding healthcare worker characteristics as barriers to implementation. For patients, the outpatient setting seemed to be a good place to be screened for fall risk. Healthcare professionals also suggested that program characteristics could enhance implementation. However, healthcare professionals' mindsets and the changing of routines are barriers that have to be addressed first.

4.
J Epidemiol Community Health ; 74(4): 354-361, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31959719

RESUMO

BACKGROUND: Interventions that reduce morbidity, in addition to mortality, warrant prioritisation. It is important to understand the magnitude of potential morbidity and health gains from changing risk factor distributions. We quantified the impact of tobacco compared with overweight/obesity eradication on future morbidity and health-adjusted life expectancy (HALE) for the New Zealand population alive in 2011. METHODS: Business-as-usual (BAU) future smoking rates were set based on past falling rates, but we assumed no future change in Body Mass Index (BMI) distribution, given historic trends. Population impact fractions and the percentage reduction in incidence rates for 16 tobacco-related and 14 overweight/obesity-related diseases (allowing for time lags) were calculated using the difference between BAU and eradication risk factor scenarios combined with tobacco and BMI incidence rate ratios. We used two multistate lifetable models to estimate HALE changes over the remaining lifespan and morbidity rate changes 30 years hence. RESULTS: HALE gains always exceeded life expectancy (LE) gains for overweight/obesity eradication (ie, absolute compression of morbidity), but for eradication of tobacco, the pattern was mixed. For example, among 32-year-olds in 2011, overweight/obesity eradication increased HALE by 2.06 years and LE by 1.21 years, compared with 0.54 and 0.50 years for tobacco eradication.Morbidity rate reductions 30 years into the future were considerably greater for overweight/obesity eradication (eg, a 15.8% reduction for 72-year-olds in 2041, or the cohort that was aged 42 years in 2011) than for tobacco eradication (2.7%). The same rate of morbidity experienced at age 65 years under BAU was deferred by 5 years with overweight/obesity eradication. CONCLUSIONS: Preventive programmes that reduce overweight and obesity have strong potential to reduce or compress morbidity, improving the average health status of ageing populations. This paper simulated eradication of tobacco and overweight/obesity; actual interventions will have lesser health impacts, but the relativities of morbidity to mortality gains should be similar.

5.
Heart ; 106(1): 40-49, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31439656

RESUMO

OBJECTIVE: To assess whether recent declines in cardiovascular mortality have benefited all socioeconomic groups equally and whether these declines have narrowed or widened inequalities in cardiovascular mortality in Europe. METHODS: In this prospective registry-based study, we determined changes in cardiovascular mortality between the 1990s and the early 2010s in 12 European populations by gender, educational level and occupational class. In order to quantify changes in the magnitude of differences in mortality, we calculated both ratio measures of relative inequalities and difference measures of absolute inequalities. RESULTS: Cardiovascular mortality has declined rapidly among lower and higher socioeconomic groups. Relative declines (%) were faster among higher socioeconomic groups; absolute declines (deaths per 100 000 person-years) were almost uniformly larger among lower socioeconomic groups. Therefore, although relative inequalities increased over time, absolute inequalities often declined substantially on all measures used. Similar trends were seen for ischaemic heart disease and cerebrovascular disease mortality separately. Best performer was England and Wales, which combined large declines in cardiovascular mortality with large reductions in absolute inequalities and stability in relative inequalities in both genders. In the early 2010s, inequalities in cardiovascular mortality were smallest in Southern Europe, of intermediate magnitude in Northern and Western Europe and largest in Central-Eastern European and Baltic countries. CONCLUSIONS: Lower socioeconomic groups have experienced remarkable declines in cardiovascular mortality rates over the last 25 years, and trends in inequalities can be qualified as favourable overall. Nevertheless, further reducing inequalities remains an important challenge for European health systems and policies.

6.
Eur J Public Health ; 30(1): 85-92, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31177272

RESUMO

BACKGROUND: In the Caribbean, life expectancy in politically independent territories has increasingly diverged from that of territories that remained affiliated to their former colonizers. Because these affiliated territories differ in degree of political independence, they are not all governed in the same way. We assessed whether differences in life expectancy trends between Caribbean dependencies and their Western administrators were related to their degree of political independence, and which causes of death contributed to divergence or convergence in life expectancy. METHODS: Analysis of age-standardized death rates and decomposition of life expectancy differences between France, the Netherlands, UK, USA and their Caribbean dependencies by age and cause-of-death during the period 1980-2014. RESULTS: Life expectancy differences between Western countries and their dependencies have generally increased for men and narrowed for women, but trends have been much more favorable in the French- than in the Dutch-administered territories. The strongest contributions to widening gaps in life expectancy between Western countries and their dependencies were from mortality from cardiovascular diseases (ischemic heart disease) and external causes (homicide and traffic accidents). CONCLUSION: Dependencies with a stronger political affiliation to a Western country experienced more favorable life expectancy developments than dependencies that had more autonomy during the 1980-2014 period. The underlying mortality differences with Western countries are largely comparable among Caribbean territories but differ in magnitude, most notably for cardiovascular disease and external causes. This suggests that increases in a territory's political autonomy impairs the diffusion of new knowledge and techniques, and/or reduces government's effectiveness in implementing policies.

7.
Eur J Epidemiol ; 34(12): 1131-1142, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31729683

RESUMO

Socioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowing inequalities. We collected and harmonised mortality data by educational level in 15 European countries over the last 25 years, and quantified changes in inequalities in mortality using a range of measures capturing different perspectives on inequality (e.g., 'relative' and 'absolute' inequalities, inequalities in 'attainment' and 'shortfall'). We determined which causes of death contributed to narrowing of inequalities, and conducted country- and period-fixed effects analyses to assess which country-level factors were associated with narrowing of inequalities in mortality. Mortality among the low educated has declined rapidly in all European countries, and a narrowing of absolute, but not relative inequalities was seen in many countries. Best performers were Austria, Italy (Turin) and Switzerland among men, and Spain (Barcelona), England and Wales, and Austria among women. Ischemic heart disease, smoking-related causes (men) and amenable causes often contributed to narrowing inequalities. Trends in income inequality, level of democracy and smoking were associated with widening inequalities, but rising health care expenditure was associated with narrowing inequalities. Trends in inequalities in mortality have not been as unfavourable as often claimed. Our results suggest that health care expansion has counteracted the inequalities widening effect of other influences.


Assuntos
Causas de Morte/tendências , Gastos em Saúde/tendências , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/tendências , Mortalidade/tendências , Classe Social , Escolaridade , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Sistema de Registros , Distribuição por Sexo , Fatores Sexuais , Fatores Socioeconômicos
8.
Lancet Public Health ; 4(10): e529-e537, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31578987

RESUMO

BACKGROUND: Socioeconomic inequalities in longevity have been found in all European countries. We aimed to assess which determinants make the largest contribution to these inequalities. METHODS: We did an international comparative study of inequalities in risk factors for shorter life expectancy in Europe. We collected register-based mortality data and survey-based risk factor data from 15 European countries. We calculated partial life expectancies between the ages of 35 years and 80 years by education and gender and determined the effect on mortality of changing the prevalence of eight risk factors-father with a manual occupation, low income, few social contacts, smoking, high alcohol consumption, high bodyweight, low physical exercise, and low fruit and vegetable consumption-among people with a low level of education to that among people with a high level of education (upward levelling scenario), using population attributable fractions. FINDINGS: In all countries, a substantial gap existed in partial life expectancy between people with low and high levels of education, of 2·3-8·2 years among men and 0·6-4·5 years among women. The risk factors contributing most to the gap in life expectancy were smoking (19·8% among men and 18·9% among women), low income (9·7% and 13·4%), and high bodyweight (7·7% and 11·7%), but large differences existed between countries in the contribution of risk factors. Sensitivity analyses using the prevalence of risk factors in the most favourable country (best practice scenario) showed that the potential for reducing the gap might be considerably smaller. The results were also sensitive to varying assumptions about the mortality risks associated with each risk factor. INTERPRETATION: Smoking, low income, and high bodyweight are quantitatively important entry points for policies to reduce educational inequalities in life expectancy in most European countries, but priorities differ between countries. A substantial reduction of inequalities in life expectancy requires policy actions on a broad range of health determinants. FUNDING: European Commission and Network for Studies on Pensions, Aging, and Retirement.

9.
Lancet Public Health ; 4(12): e607-e617, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31530472

RESUMO

BACKGROUND: Comprehensive tobacco control policies can help to protect children from tobacco smoke exposure and associated adverse respiratory health consequences. We investigated the impact of England's 2015 regulation that prohibits smoking in a private vehicle with children present on changes in environmental tobacco smoke exposure and respiratory health in children. METHODS: In this quasi-experimental study, we used repeated cross-sectional, nationally representative data from the Health Survey for England from Jan 1, 2008, to Dec 31, 2017, of children aged up to 15 years. We did interrupted time series logistic or ordinal regression analyses to assess changes in prevalence of self-reported respiratory conditions, prevalence of self-reported childhood tobacco smoke exposure (children aged 8-15 years only), and salivary cotinine levels (children aged 2 years or older) before and after implementation of the smoke-free private vehicle regulation on Oct 1, 2015. Children who were considered active smokers were excluded from the analyses of salivary cotinine levels. Our primary outcome of interest was self-reported current wheezing or asthma, defined as having medicines prescribed for these conditions. Analyses were adjusted for underlying time trends, quarter of year, sex, age, Index of Multiple Deprivation quintile, and urbanisation level. FINDINGS: 21 096 children aged 0-15 years were included in our dataset. Implementation of the smoke-free private vehicle regulation was not associated with a demonstrable change in self-reported current wheezing or asthma (adjusted odds ratio 0·81, 95% CI 0·62-1·05; p=0·108; assessed in 13 369 children), respiratory conditions (1·02, 0·80-1·29; p=0·892; assessed in 17 006 children), or respiratory conditions probably affecting stamina, breathing, or fatigue (0·75, 0·47-1·19; p=0·220; assessed in 12 386 children). Self-reported tobacco smoke exposure and salivary cotinine levels generally decreased over the study period. There was no additional change in self-reported tobacco smoke exposure in cars among children aged 8-15 years following the legislation (0·77, 0·51-1·17; p=0·222; assessed in 5399 children). We observed a relative increase in the odds of children having detectable salivary cotinine levels post legislation (1·36, 1·09-1·71; p=0·0074; assessed in 7858 children) and levels were also higher (1·30, 1·04-1·62; p=0·020; ordinal variable). Despite introduction of the regulation, one in 20 children still reported being regularly exposed to tobacco smoke in cars and one in three still had detectable salivary cotinine levels. INTERPRETATION: We found no demonstrable association between the implementation of England's smoke-free private vehicle regulation and changes in children's self-reported tobacco smoke exposure or respiratory health. There is an urgent need to develop more effective approaches to protect children from tobacco smoke in various places, including in private vehicles. FUNDING: Netherlands Lung Foundation, Erasmus MC, Farr Institute, Health Data Research UK, Asthma UK Centre for Applied Research, Academy of Medical Sciences, and Newton Fund.

11.
Int J Public Health ; 64(7): 1037-1047, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31187165

RESUMO

OBJECTIVES: To explore whether 'distinction', a well-known mechanism that produces and reproduces social inequalities, can explain the socio-economic gradient in healthy diet and physical activity in contemporary obesogenic environments. If this is the case, we would expect a well-established indicator of distinction, 'highbrow' cultural participation, to be associated with a healthy diet and physical activity, while adjusting for education and income. METHODS: Data from participants (25-75 years) of the 2014 wave of the Dutch GLOBE study (N = 2812) were used to analyse the association between 'highbrow' cultural participation (e.g. annual frequency of visits to museums, ballet, concerts, theatre) and sports participation, leisure-time walking and cycling, and fruit and vegetable intake, adjusted for education, income and other confounders. RESULTS: Both highbrow cultural participation and healthy behaviours were more prevalent among high educational groups. Cultural participation was strongly associated with all health behaviours, even when adjusted for education and income. CONCLUSIONS: Our findings suggest that health behaviours, similar to highbrow cultural participation, are adopted as an expression of social distinction. This distinction mechanism may be an important determinant of health behaviour inequalities.


Assuntos
Arte , Exercício Físico , Comportamentos Relacionados com a Saúde , Adulto , Idoso , Estudos Transversais , Feminino , Frutas , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Países Baixos , Prevalência , Fatores Socioeconômicos , Esportes
12.
Int J Public Health ; 64(6): 861-872, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31183533

RESUMO

OBJECTIVES: To assess to what extent educational differences in total life expectancy (TLE) and disability-free life expectancy (DFLE) could be reduced by improving fruit and vegetable consumption in ten European countries. METHODS: Data from national census or registries with mortality follow-up, EU-SILC, and ESS were used in two scenarios to calculate the impact: the upward levelling scenario (exposure in low educated equals exposure in high educated) and the elimination scenario (no exposure in both groups). Results are estimated for men and women between ages 35 and 79 years. RESULTS: Varying by country, upward levelling reduced inequalities in DFLE by 0.1-1.1 years (1-10%) in males, and by 0.0-1.3 years (0-18%) in females. Eliminating exposure reduced inequalities in DFLE between 0.6 and 1.7 years for males (6-15%), and between 0.1 years and 1.8 years for females (3-20%). CONCLUSIONS: Upward levelling of fruit and vegetable consumption would have a small, positive effect on both TLE and DFLE, and could potentially reduce inequalities in TLE and DFLE.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Comportamento Alimentar/psicologia , Frutas , Disparidades nos Níveis de Saúde , Expectativa de Vida , Verduras , Adulto , Idoso , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
13.
Soc Sci Med ; 234: 112371, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31254964

RESUMO

Inequalities in health are pervasive and durable, but they are not uniform. To date, however, the drivers of these between-country patters in health inequalities remain largely unknown. In this analysis, we draw on data from 17 European countries to explore whether inequalities in political participation, that is, inequalities in voting by educational attainment, are correlated with health inequalities. Over and above a range of relevant confounders, such as GDP, income inequality, health spending, social protection spending, poverty rates, and smoking, greater inequalities in political participation remain correlated with higher health inequalities. If 'politicians and officials are under no compulsion to pay much heed to classes and groups of citizens that do not vote' then political inequalities could indirectly affect health through its impact on policy choices that determine who has access to the resources necessary for a healthy life. Inequalities in political participation, then, may well be one of the 'causes of the causes' of ill-health.

14.
J Epidemiol Community Health ; 73(8): 750-758, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31142611

RESUMO

BACKGROUND: We compared mortality inequalities by occupational class in Japan and South Korea with those in European countries, in order to determine whether patterns are similar. METHODS: National register-based data from Japan, South Korea and eight European countries (Finland, Denmark, England/Wales, France, Switzerland, Italy (Turin), Estonia, Lithuania) covering the period between 1990 and 2015 were collected and harmonised. We calculated age-standardised all-cause and cause-specific mortality among men aged 35-64 by occupational class and measured the magnitude of inequality with rate differences, rate ratios and the average inter-group difference. RESULTS: Clear gradients in mortality were found in all European countries throughout the study period: manual workers had 1.6-2.5 times higher mortality than upper non-manual workers. However, in the most recent time-period, upper non-manual workers had higher mortality than manual workers in Japan and South Korea. This pattern emerged as a result of a rise in mortality among the upper non-manual group in Japan during the late 1990s, and in South Korea during the late 2000s, due to rising mortality from cancer and external causes (including suicide), in addition to strong mortality declines among lower non-manual and manual workers. CONCLUSION: Patterns of mortality by occupational class are remarkably different between European countries and Japan and South Korea. The recently observed patterns in the latter two countries may be related to a larger impact on the higher occupational classes of the economic crisis of the late 1990s and the late 2000s, respectively, and show that a high socioeconomic position does not guarantee better health.

15.
Z Gerontol Geriatr ; 52(2): 122-129, 2019 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-30874944

RESUMO

BACKGROUND: In 1989 the first international comparisons of mortality differences according to educational level and occupational status were published. A few years later systematic comparisons between European countries were initiated at the Erasmus University in Rotterdam. This became a trigger for several European Union (EU)-funded collaboration programs scrutinizing social inequalities in health. The collaboration revealed substantial differences in mortality within and between European populations. OBJECTIVE: This article provides a synthesis of the most important research results over the past 30 years and also identifies existing research gaps and potentials. MATERIAL AND METHODS: Descriptive summary of research results comparing European countries regarding male and female all-cause and cause-specific mortality according to educational level and occupational status. RESULTS: In all European populations analyzed there was a consistent gradient with substantial and in part increasing advantages for higher socioeconomic status groups. There is, however, substantial variation between individual countries. This also applies to trends and cause of death-specific analyses. While relative differences have increased in virtually all populations, absolute differences have often decreased in many populations. Among women and in higher ages the relative differences were smaller. Within Europe, the southern countries had the smallest and the eastern countries the largest gradients. Tobacco and alcohol-related diseases had an especially noteworthy impact on trends and gradients. CONCLUSION: The evidence for social health inequalities and their determinants has substantially improved during the past 30 years; however, there remains substantial potential for future research questions, for example concerning the contribution of the different phases of life to healthy aging.


Assuntos
Disparidades nos Níveis de Saúde , Mortalidade , Classe Social , Escolaridade , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Mortalidade/tendências , Fatores Socioeconômicos
16.
Eur J Public Health ; 29(4): 640-647, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30753498

RESUMO

BACKGROUND: Previous studies have shown the existence of social inequalities in disability in many European countries. However, it is not clear what factors are associated with these inequalities. The aim of this study was to assess the contribution of behavioral factors, work-related factors and living conditions to educational inequalities in disability. METHODS: We pooled data from the seventh wave of the European Social Survey (2014) which included self-reported disability measured with the Global Activity Limitations Indicator for 19 European countries. We used multivariate logistic regression to determine the contributions of behavioral factors, work-related and living conditions to educational inequalities in disability among respondents aged 30-79. RESULTS: We found that adjusting simultaneously for three groups of determinants (behavioral, work-related and living conditions) reduces the greatest proportion of inequalities in disability in both men and women, in a range >70%. Each group of determinants contributes substantially to explain inequalities in disability. CONCLUSIONS: Inequalities in disability are a major challenge for public health in most European countries. Our findings suggest that these inequalities can be reduced by diminishing inequalities in exposure to well-known health determinants.

17.
Am J Public Health ; 109(4): 626-632, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30789765

RESUMO

OBJECTIVES: To determine whether Caribbean states vary in health policy performance in 11 different areas; to explore the association with sociodemographic, economical, and governance determinants; and to estimate the potential health gains of "best-practice" health policies. METHODS: We selected 50 indicators that included data on mortality (latest available, 2010-2015), intermediate outcomes, and policy implementation to calculate a state's health policy performance score. We related this score to country characteristics and calculated the potential number of avoidable deaths if the age-specific mortality rates of best-performer Martinique applied in all states. RESULTS: We found large differences in health policy performance among Caribbean states. Martinique, Cuba, and Guadeloupe had the highest performance scores, and Guyana, Belize, and Suriname the lowest. Political affiliation, religious fractionalization, corruption, national income, and population density were associated with health policy performance. If the mortality rates of Martinique applied to all Caribbean states, an overall mortality reduction of 12% would be achieved. CONCLUSIONS: Differences in health outcomes between Caribbean states are partly attributable to variations in health policy implementation. Our results suggest that many deaths can be prevented if Caribbean governments adopt best-practice policies.


Assuntos
Implementação de Plano de Saúde/estatística & dados numéricos , Política de Saúde/economia , Política de Saúde/tendências , Região do Caribe , Países em Desenvolvimento , Humanos , Mortalidade/tendências , Densidade Demográfica , Guias de Prática Clínica como Assunto/normas , Fatores Socioeconômicos
18.
Int J Public Health ; 64(3): 461-474, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30478617

RESUMO

OBJECTIVES: To assess the sensitivity of prevalence and inequality estimates of Global Activity Limitation Indicator (GALI) to the choice of survey in European countries. METHODS: We use logistic regression to estimate adjusted risk ratios, quantifying differences in prevalence and educational inequalities, the impact of survey characteristics and Kendall's tau to assess similarity in country rankings between surveys. We include the European Health Interview Survey (EHIS), European Social Survey (ESS) and European Union Statistics on Income and Living Conditions (EU-SILC). RESULTS: EHIS estimates higher prevalence than EU-SILC 17% (men) and 23% (women), and ESS 24% (men) and 29% (women). Prevalence does not differ significantly between EU-SILC and ESS. EU-SILC estimates 52.5% (men) and 28.1% (women) higher inequalities than EHIS and 63.2% (men) and 32.7% (women) higher inequalities than ESS. Survey characteristics do not account for differences in prevalence or inequalities. Country rankings do not agree for prevalence or inequalities. CONCLUSIONS: Survey choice strongly impacts estimates of GALI prevalence and educational inequalities. Further study is necessary to understand these discrepancies. Caution is required when using these surveys for cross-country comparisons of (educational inequalities in) GALI disability.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Escolaridade , Indicadores Básicos de Saúde , Nível de Saúde , Inquéritos Epidemiológicos , Fatores Socioeconômicos , Adulto , Idoso , Europa (Continente) , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances
19.
BMC Public Health ; 18(1): 1105, 2018 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-30200912

RESUMO

BACKGROUND: Material and behavioural factors play an important role in explaining educational inequalities in mortality, but gender differences in these contributions have received little attention thus far. We examined the contribution of a range of possible mediators to relative educational inequalities in mortality for men and women separately. METHODS: Baseline data (1991) of men and women aged 25 to 74 years participating in the prospective Dutch GLOBE study were linked to almost 23 years of mortality follow-up from Dutch registry data (6099 men and 6935 women). Cox proportional hazard models were used to calculate hazard ratios with 95% confidence intervals, and to investigate the contribution of material (financial difficulties, housing tenure, health insurance), employment-related (type of employment, occupational class of the breadwinner), behavioural (alcohol consumption, smoking, leisure and sports physical activity, body mass index) and family-related factors (marital status, living arrangement, number of children) to educational inequalities in all-cause and cause-specific mortality, i.e. mortality from cancer, cardiovascular disease, other diseases and external causes. RESULTS: Educational gradients in mortality were found for both men and women. All factors together explained 62% of educational inequalities in mortality for lowest educated men, and 71% for lowest educated women. Yet, type of employment contributed substantially more to the explanation of educational inequalities in all-cause mortality for men (29%) than for women (- 7%), whereas the breadwinner's occupational class contributed more for women (41%) than for men (7%). Material factors and employment-related factors contributed more to inequalities in mortality from cardiovascular disease for men than for women, but they explained more of the inequalities in cancer mortality for women than for men. CONCLUSIONS: Gender differences in the contribution of employment-related factors to the explanation of educational inequalities in all-cause mortality were found, but not of material, behavioural or family-related factors. A full understanding of educational inequalities in mortality benefits from a gender perspective, particularly when considering employment-related factors.


Assuntos
Escolaridade , Disparidades nos Níveis de Saúde , Mortalidade , Adulto , Idoso , Causas de Morte , Emprego/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Estudos Prospectivos , Sistema de Registros , Distribuição por Sexo
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